The Lancet – “Benefits and risks of homoeopathy”

November 16th, 2007 by Ben Goldacre in bad science, homeopathy | 83 Comments »

This is a piece I wrote in today’s edition of The Lancet. You can also see this article there in a nice Lancet PDF, along with a “world report” on homeopathy, and the references in pleasantly accessible Crossref format. To be honest, it almost feels silly writing about homeopathy in the Lancet.

“Benefits and risks of homoeopathy”

www.thelancet.com/journals/lancet/article/PIIS0140673607617061/fulltext

Five large meta-analyses of homoeopathy trials have
been done. All have had the same result: after excluding
methodologically inadequate trials and accounting for
publication bias, homoeopathy produced no statistically
significant benefit over placebo.[1–5] And yet homoeopathy
can still be clinically useful.

During the cholera epidemic in the 19th century,
death rates at the London Homoeopathic Hospital
were three times lower than those at the Middlesex
Hospital.[6] The reason for homoeopathy’s success in this
epidemic is even more interesting than the placebo
effect. At the time, nobody could treat cholera, and
while medical treatments such as blood-letting were
actively harmful, the homoeopaths’ treatments were at
least inert.

Similarly, modern medicine can offer little for conditions
such as many types of back pain, stress at work, medically
unexplained fatigue, and most common colds. Going
through a theatre of medical treatment, and trying every
drug in the book, will only elicit side-effects. An inert pill
in these circumstances seems a sensible option.

However, just as homoeopathy has unexpected
benefits, so it can have unexpected side-effects. The very
act of prescribing a pill carries its own risks: medicalisation,
reinforcement of counterproductive illness behaviours,
and promotion of the idea that a pill is an appropriate
response to a social problem, or a modest viral illness.
Similarly, when a health-care practitioner of any
description prescribes a pill which they know is no more
effective than placebo—without disclosing that fact to

their patient—then they disregard both informed consent
and their patient’s autonomy. Some could argue that this
cost is acceptable, but such old-fashioned paternalism can
ultimately undermine the doctor–patient relationship.

There are also more concrete harms. A routine feature
of homoeopaths’ marketing practices is to denigrate
mainstream medicine. One study found that half of all
homoeopaths who were approached advised patients
against the measles, mumps, and rubella vaccine for
their children.[7] A television news investigation found
that almost all homoeopaths who were approached
recommended ineffective homoeopathic prophylaxis for
malaria, undermined medical prophylaxis, and did not
even give simple advice on bite prevention.[8] Undermining
medicine is a wise commercial decision for homoeopaths,
because survey data show that a disappointing experience
with mainstream medicine is one of the few features
to regularly correlate with a decision to use alternative
therapies. But it might not be a responsible choice.

Homoeopaths can undermine public-health campaigns;
leave their patients exposed to fatal diseases; and, in the
extreme, miss or disregard fatal diagnoses. There have
also been cases of patients who died after medically
trained homoeopaths advised them to stop medical
treatments for serious medical conditions.[9,10]

All these problems have been exacerbated by
society’s eagerness to endorse the healing claims of
homoeopaths, and by the lack of a culture of critical
self-appraisal in alternative medicine. Publication bias
in alternative therapy journals is high: in 2000, only 5%
of studies published in complementary or alternative
health journals were negative.[11] To my knowledge, the
ethical issues of autonomy and placebo have never been
discussed. Homoeopaths routinely respond to negative
meta-analyses by cherry-picking positive studies. An
observational study,[12] which amounts to little more than a
customer-satisfaction survey, has been promoted[13] as if it
trumps a string of randomised trials.

Homoeopaths can misrepresent scientific evidence
freely to an unsuspecting and scientifically illiterate public,
but in doing so they undermine the public understanding
of what it means to have an evidence base for a treatment.
This approach seems particularly egregious when
academics are working harder than ever to engage the
wider public in a genuine understanding of research,14 and
when most good doctors try to educate and involve their
patients in the selection of treatment options.

Every criticism I have made could be managed
with clear and open discussion of the problems.
But homoeopaths have walled themselves off from
academic medicine, and critique has been all too often
met with avoidance rather than argument. The Society
of Homeopaths (in Europe) has even threatened to sue
bloggers,[15] and the university courses on alternative
medicine which I and others have approached have flatly
refused to provide basic information, such as what they
teach and how.[16] It is hard to think of anything more
unhealthy.

To ban homoeopathy would be an over-reaction, as
placebos could have a clinical role. However, whether the
placebo effect is best harnessed by homoeopaths will
remain questionable until these ethical issues and sideeffects
have been addressed.

Ben Goldacre
The Guardian, London EC1R 3ER, UK
ben@badscience.net

I am a medical doctor who is also employed by the media as a commentator on pseudoscience and the sociology of medicine.

1 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. BMJ 1991;
302: 316–23.

2 Boissel JP, Cucherat M, Haugh M, Gauthier E. Critical literature review on the
effectiveness of homoeopathy: overview of data from homoeopathic
medicine trials. Brussels, Belgium: Homoeopathic Medicine Research Group.
Report to the European Commission. 1996: 195–210.

3 Linde K, Melchart D. Randomized controlled trials of individualized
homeopathy: a state-of-the-art review. J Alter Complement Med 1998;
4: 371–88.

4 Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of
homeopathy: a meta-analysis of clinical trials. Eur J Clin Pharmacol 2000;
56: 27–33.

5 Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of
homoeopathy placebo effects? Comparative study of placebo-controlled
trials of homoeopathy and allopathy. Lancet 2005; 366: 726–32.

6 Hempel S. The medical detective. London, UK: Granta Books, 2006.

7 Schmidt K, Ernst E. Aspects of MMR. BMJ 2002; 325: 597.

8 Jones M. Malaria advice ‘risks lives’. Newsnight, BBC2 July 13, 2006. news.
bbc.co.uk/1/hi/programmes/newsnight/5178122.stm (accessed Nov 8, 2007).

9 General Medical Council Fitness To Practise Panel. Dr Marisa Viegas. 2007.
www.gmc-uk.org/concerns/hearings_and_decisions/ftp/20070628_
ftp_panel_viegas.asp (accessed Nov 8, 2007).

10 Sheldon T. Dutch doctor struck off for alternative care of actor dying of cancer.
BMJ 2007; 335: 13.

11 Schmidt K, Pittler M, Ernst E. Bias in alternative medicine is still rife but is
diminishing. BMJ 2001; 323: 1071.

12 Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for
chronic disease: a 6-year, university-hospital outpatient observational
study. J Altern Complement Med 2005; 11: 793–98.

13 Grice E. Keep taking the arsenic. Daily Telegraph Nov 25, 2005.
www.telegraph.co.uk/health/main.jhtml?view=DETAILS&grid=
P8&xml=/health/2005/11/25/hhomeo25.xml (accessed Nov 8, 2007).

14 Evans I, Thornton H, Chalmers I. Testing treatments: better research for better
healthcare. London, UK: British Library, 2006.

15 Goldacre B. Threats, the homeopathic panacea. Guardian Oct 20, 2007.
www.guardian.co.uk/science/2007/oct/20/homeopathy (accessed
Nov 6, 2007).

16 Giles J. Degrees in homeopathy slated as unscientific. Nature 2007;
446: 352–53.

 


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83 Responses



  1. BSM said,

    November 26, 2007 at 8:19 am

    “I still think you are acting inconsistently by not demanding an RCT of coffee or alcohol to be performed, because you are making a judgement from observation (your experience) which you forbid me to make based on my observational experience.”

    Strictly speaking, I forbid anyone to make such judgements, myself included.

    What you demand is the right to make judgements without oversight by RCT when, as I have clearly demonstrated, such judgements are woefully inaccurate.

    My problem with you is that you then translate that obstinate error into a demand to be left alone to make a living from that error.

    “It is based on this reading of the science that I base my conviction about homeopathy, apart from the fact of helping people with conditions considered incurable…”

    Oh, yes the claim to help the “incurable”. Since you bring this matter up;

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

    Do that and I’ll grant you have a legitimate right to take people’s money for your sugar. You have an entire 200 years of history and I’ll take evidence from any species or any country so you needn’t bother with the excuse that poor downtrodden homeopaths aren’t allowed near seriously ill people in your jurisdiction.

  2. BSM said,

    November 26, 2007 at 11:31 am

    “And are these not distinct and measurable effects?”

    And the homeopaths are keen to tell us how they ‘cure’ people, so they are certainly applying some sort of criterion to define when their remedies have succeeded.

    Basically, when they want to sell people sugar they’re full of confidence in the reliability and reproducibility of what they do. When less friendly eyes want to scrutinise them, all this certainty disappears out the window.

  3. David / Homeopathy Zone said,

    November 26, 2007 at 2:49 pm

    Bass Tyrrell,

    My point about hom. remedies not having distinct effects is that it acts as a “catalyst” on the “reactions” the organism undergoes rather than as a “reagent”. This is also the reason why its effects mimic natural healing patterns. Sometimes catalysts accelerate reactions that would have happened anyway, as in your toothache example (so it’s difficult or impossible to determine from clinical observation whether this is the case), but sometimes that cause reaction to happen that would never happen otherwise (as in non-self-limiting chronic degenerative conditions).

    In order to research hom. adequately one would have to account for complex situations such as a patient reporting the worsening of his 5 leading physical complaints concurrent with an improvement in sleep during the first weeks of treatment. Such a pattern is a favorable outcome that is an excellent predictor or an eventual improvement of those symtpoms. It is this long-term perspective that has to be factored into long-term studies with a sophisticated design that takes into account that an aggravation is sometimes a good sign and not a side-effect or a worsening of the condition — but this is determined in consideration of other symptoms, as symptoms are not independent variables. I am not aware of any such designs at this point. One PCRCT design I can see working is one where no limitations on clinical method are imposed and a sufficient time is given to obtain results (say 2 years in chronic complaints), with gradated (non-binary) outcome measures that include subjective quality-of-life questionnaires alongside objective measures).

    Here is an interesting article on the topic of the complex nature of the clinical response to homeopathy. It may seem like rubbish until one witnesses these effects in the clinic on a startlingly regular basis.

    BSM,

    “GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.”

    I am unclear as to whether you are asking for anecdotal evidence or studies, and what are or aren’t self-limiting conditions in your definition, given that virtually any condition can theoretically show so-called “sponteneous remission”.

    If you are asking for studies and for general evidence that hom. might be possible, I don’t see why you should reject studies of non self-limiting conditions that produce statistically significant results (even if they can be claimed to be clinically negligible), such as some of the Oscilococcinum studies (non-individualized hom. treatment for flu). I mentioned above the challenges of doing studies of chronic conditions and most existing studies are of acute conditions (though hopefully in time longer-term invfestigation will be made), but statistical methods ensure that even self-limiting conditions can be investigated reliably.

    If you are asking for anecdotal evidence then I don’t know where to begin, as there are so many. You can look up homeopathic journals, but then whatever is in them can be dismissed as rubbish. I could tell you concrete clinical cases; but you would dismiss them in one way or another. So my question is what sort of authority, evidence, and references you’d require, and what are some medical conditions you’d include in the list?

    The criteria that homeopaths apply to judge improvement are described in the link to the article above. Basically an overall change for the better is looked for (energy level, sleep, mood, sense of control of one’s life, etc.) alongide an improvement in medical complaints, where the most important is the subjective discomfort (e.g. pain disappearing), followed by objective measures such as x-rays or blood tests. There is no single, clearcut criterion for every disease because the patient’s sense of well-being is the primary criterion (recognizing that this sense is sometimes deceiving); this contrasts with situations in conventional medical practice where all objective criteria of health are satisfied yet the patient is clearly in suffering. Neither of these two approaches is fault-proof.

  4. BSM said,

    November 26, 2007 at 3:21 pm

    David

    I am not for now interested in the controlled studies. None support your case, indeed it is a big fat lie that they do for Oscillococcinum, but you may not have read the studies themselves so I’ll grant that it may instead be a big fat couldn’t be bothered to look at the primary literature but I believe what I read on homeopathic websites.

    “If you are asking for anecdotal evidence then I don’t know where to begin, as there are so many. ”

    Actually there aren’t and I’d like you to produce one, please.

    You see, we get this claim time and again from homeopaths. You have just made the claim yourself

    ” but sometimes that cause reaction to happen that would never happen otherwise (as in non-self-limiting chronic degenerative conditions).”

    but even on a case-anecdotal basis this seems to be, now how can I put this delicately, an enormous flat-out lie.

    It would probably be best to report something from your own cases because you can then be confident that it is well documented and will stand up to scrutiny.

    And before you go off on a tangent about sceptics not wanting to believe anecdotes all I’m trying to demonstrate to you is that regardless of its failure in controlled trials, even the anecdotal record of homeopathy is based on falsehoods.

    So, a nice clear-cut cure of cancer, please. Or an AIDS patient cured. End-stage renal failure. Cirrhosis of the liver. Something impressive.

    Off you go now and have a think…

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

  5. David / Homeopathy Zone said,

    November 26, 2007 at 4:35 pm

    BSM,

    Your contempt for everything homeopathic precludes you from impartially investigating the issue.

    You must be aware that there are case reports in the medical literature of all sorts of non-self-limiting conditions showing spontaneous recovery or placebo response. So any evidence I will give you will not in itself prove anything. More broadly, nothing that I will say will obviate the need for you to enter a busy clinical setting and observe for a sufficient length or time, in order to make an informed judgement.

    A couple of impressive reversals of degenerative conditions that I have been privy to:
    1) Full recovery from serious (functionally fused spine with extensive calcification) ankylosing spondilitis over a 5 year period, in an ongoing teaching clinic where I have had the opportunity of observing for the past 2 years. X-rays were of course performed, and slight abnormalities remain on x-ray (these may improve over time as the case is still being followed up), but flexibility is within normal range and the patient is pain-free.
    2) Recovery from MS (ascending lower body paralysis threatening the diaphragm) over a 6 year period to the point of being able to walk for 1 hour a day (not a full cure? good enough for me!). This is a case recorded on video, and the patient can be seen to be older over time so it wasn’t filmed in reverse (but then it could have all been acted up!).

    I don’t have such impressive cases myself as I have only been in practice for 3-4 years and am only lately beginning to take on really complex cases. An example I consider impressive is in someone I have known for over 20 years, a young woman with developmental difficulties (learning disabilities, depression, aversion to washing for weeks at a time, sensitive to insult to which she would react in rage) and for the past 5 years before treatment, eczema on her face and chest. Over a 1.5 year period of treatment her eczema disappeared (self-limiting), her mood transformed for the better, aversion to washing disappeared, sensitivity to insult gone, and — this is the deepest sign of cure — she is fast transforming from looking boyish to maturing into a woman. In time her learning difficulties may improve, and she is not fully healthy, but this is more than enough of a ‘cure’/ The complex of these symptoms is, in principle, something that could occur through normal development, but as someone who was stuck in the same developmental status from birth (there was birth trauma) or at least from ages 5 (when I first saw her) to 25 and suddenly in 2 years made such a leap, this is impressive clinical evidence.

    Again, this is unconvincing until you see it yourself. Absent your willingness to do so, you have no basis on which to claim that these results are irrelevant as evidence, and conversely I am not presenting this as evidence for homeopathy but as an illustration of the sort of evidence that I base my judgements on.

    I don’t think we can progress beyond here unless you are willing to consider the validity of clinical observation. I am well aware of the limitations of such observations vis-a-vis the positivistic enterprise of EBM, but clinical outcomes speak to the validity of such an approach, and these can be reserached with comparative observational studies, which I believe are the wave of the future in a sustainable health-care system. Again, I am willing to take the logical possibility that all I am doing is placebo if I get great clinical results, and conversely I find no solace in the abstract beauty of the ideal of the RCT as the gold standard unless it can help me to achieve such results. I will repeat that Communism also used rationalistic principles to justify itself, but in real life it proved limiting and ultimately destructive (even though certain of its ideas are very much applicable in a healthy democracy).

  6. Bass Tyrrell said,

    November 26, 2007 at 5:46 pm

    BSM: “being dead is a sub-optimal outcome ” – since the patient then presumably would not fill out their “subjective quality-of-life questionnaire” they could simply be regarded as non-cooperative.

  7. BSM said,

    November 26, 2007 at 7:42 pm

    So, David, I’ll take that as a ‘no’.

    Doi you really mean to tell me that out of the entire 200-year history of homeopathy there is nothing better that you can find. And these cases aren’t ‘cured’ by even your relaxed standards.

    Come on, man. You’ve been taught by homeopaths. You’ve read the books. Homeopathy is a ‘complete system of medicine’ able to cure the incurable cases.

    Please try harder.

    Also, can we please just drop this stupid assertion;

    “I don’t think we can progress beyond here unless you are willing to consider the validity of clinical observation”

    I may only be a veterinarian, but that still makes me more of a clinician than you are. I am well aware of what it means to make clinical observations. We have already demonstrated that clinical observation cannot trump controlled data and is wrong in a frustratingly high proportion of instances especially when the symptoms are highly subjective. I have no problem with accepting that clinical observation often leads to false inferences. You have a weird little straitjacket applied to the way you approach your cases if you take your own observations at face value.

    Why do you persist in this false belief?

    “and these can be reserached with comparative observational studies”

    Define ‘comparative observational studies’.

    The relevant studies are homeopathy with ‘real’ remedies and homeopathy with ‘blanks’. This has been done, David. Time and again it has been done. Homeopathy’s little pills do not work. Why can you not accept this and earn an honest living as a counsellor instead of the dishonest and deceitful path you are embarked upon? It really is quite tragic that you would choose to throw away your life on this stuff.

    “find no solace in the abstract beauty of the ideal of the RCT as the gold standard unless it can help me to achieve such results”

    But is has done exactly what one requires of it. It has shown you to forget homeopathy’s little pills. You just don’t want to be told that.

    The reference to Communism is just weird and irrelevant.

  8. BSM said,

    November 26, 2007 at 8:06 pm

    I ought to say specifically with respect to;

    ” birth (there was birth trauma) or at least from ages 5 (when I first saw her) to 25 and suddenly in 2 years made such a leap, this is impressive clinical evidence.”

    It really, really isn’t. I am just dumbfounded that you would even bother to bring forward a case like that.

    p.s. With your ankylosing spondylitis, I take it that no other treatment has been given and that no physiotherapy has been undertaken or else why would you present it here. Please confirm that homeopathy alone was used. By the way, I have a staff member with ankylosing spondylitis. That has remitted as well (for now). Ain’t nature wonderful if left to get on with things…oops, you wanted that to be a sugar-pill effect, sorry.

    Homeopathy = Too easily impressed.

  9. Bass Tyrrell said,

    November 26, 2007 at 9:20 pm

    David / Homoeopathy Zone: writes “My point about hom. remedies not having distinct effects is that it acts as a “catalyst” on the “reactions” the organism undergoes rather than as a “reagent”. This is also the reason why its effects mimic natural healing patterns. Sometimes catalysts accelerate reactions that would have happened anyway, as in your toothache example (so it’s difficult or impossible to determine from clinical observation whether this is the case), but sometimes that cause reaction to happen that would never happen otherwise (as in non-self-limiting chronic degenerative conditions).” This is pure unadulterated nonsense of a high degree. Exactly what you are trying to say with your distinction between a catalyst and a reagent is far from clear but irrelevant in any case: if you administer a substance and it has an effect it is possible to measure the effect! As for “cause reaction to happen that would never happen otherwise” this would hardly be natural healing now, would it?

    You are full of excuses as to why you cannot possibly isolate single variables to test them. But if you ever want homoeopathy to be taken seriously you need to find a way of doing so – nothing, but nothing, that has been said here has made any sort of a case as to why this is impossible or even impractical. Your latest effort focused on cost. But there James Randi’s one million US out there, or if that is too risky because it wouldn’t be paid until after proof came along surely homoeopathy has some rich clients who would gladly fund the necessary research (the author Jeanette Winterson maybe)? And even if none of those come up trumps, you could always enlist the help of Big Pharma! Because you know what, if you could provide even relatively weak evidence to Pfizer, GSK, Bayer or similar company they would jump at the chance to make effective medication with such a low manufacturing cost. They would even help design the study (as will the JREF people too).

    By the way, the toothache example was, deliberately, ridiculous (even though it is a true story). That you even entertain the notion that the remedy could be claimed to have some effect in that case shows how far you are from reality.

  10. David / Homeopathy Zone said,

    November 26, 2007 at 9:29 pm

    BSM,

    The AS case was severe enough that you would be suprised if it remitted; certainly his doctors were. Not proof, just compelling evidence (for gullible me).

    Re my case: You to fail to see that such cases are precisely the sort of thing that constitutes true healing as opposed to symptom removal. I cannot convey it in words, but her whole being transoformed in less than two years in a way that it hadn’t in all her life up until then (I brought up this case precisely because it’s one where I’d had first-hand evidence of her past state). You cannot dismiss such a change in her developmental trajectory (she was 25 at the beginning of treatment so it wasn’t puberty related but a highly atypical global shift in an adult) as unimpressive, nor can you reproduce it with conventional medications except possibly when growth hormone is indicated.

    It is notable that conventional medicines that she had received on and off through her life did not bring her to this state at any time, nor did various psychological treatments. But I cannot explain what healing means to one who is intersted in numbers and pathologies alone, I am sorry.

    If you are genuinely interested in well-recorded cases histories of severe pathologies and cancer I can recommend contacting Andre Saine, a senior homeopath from Montreal, here, who might be willing to provide such material, as he’s made it his speciality to treat precisely the sort of complex cases that you suggest might impress you.

  11. BSM said,

    November 27, 2007 at 9:36 am

    No, David, I am asking you to provide the evidence.

    By trying to pass the buck you are conceding my point.

    These dramatic cures always seem to happen with someone else never to the particular homeopath that one is asking. I can accept that you are inexperienced, but you are supposed to be familiar with your own literature, so find a case that has been properly documented.

    Try again,

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

    With respect your spondylitis case and your developmental neurology woman, I shall simply repeat that you are far too easily impressed, and I shall also repeat my request that you confirm that neither patient received any other intervention either medical, physical or psychological while they were under homeopathic treatment. Now that is something you have direct access to, so please be so good as to answer clearly and succinctly.

  12. BSM said,

    November 27, 2007 at 9:47 am

    Hang on a sec’ you said that the spondylitis patient had X-rays, so they are under conventional medical care.

    Are you claiming that conventional medicine was used to monitor the patient but absolutely no other conventional interventions were made? That would seem inherently unlikely. Please confirm exactly what was going on.

  13. David / Homeopathy Zone said,

    November 27, 2007 at 8:44 pm

    BSM,

    The AS patient was definitely on medications concurrently, anti-inflammatories and painkillers as needed. But they were gradually weaned over the treatment period and eventually discontinued during the 5th year of treatment.

  14. David / Homeopathy Zone said,

    November 27, 2007 at 10:02 pm

    … With regard to journal cases: I requested specific criteria before I could supply you evidence, as I am not interested in playing a game where I am bringing evidence and you get to specify criteria after-the-fact.

    Besides, the best evidence I can provide you is my own or that which I have observed as a third-party or that by those whom I personally trust. These is more reliable evidence in my mind than journal cases that don’t undergo formal peer-review of the sort you would approve of and are often poorly written up.

    Your request for cures of what is end-stage, probably irreversible pathology are not reasonable, though I did refer you to someone who is a widely recongized expert on precisely this sort of evidence. I still require a definition or list of pathologies that are not self-limiting yet curable in priniple. MS? (Yes it is subject to remissions in many instances but mostly symptomatically rather than pathologically, and hardly in the severe case that I described above, which you didn’t address) Advanced ankylosing spondylitis? You are unimpressed. Lifelong developmental delays? You are unimpressed.

    So please specify your criteria. You still didn’t address my comment that even extreme conditions have been recorded to have reversed for unkown reasons so I don’t see how any example I would give is not dismissible as either placebo or spontaneous remission. What is “incontrovertible” when you fundamentally mistrust the reporter’s credibility and I cannot supply you the patient in “before” and “after” stages for your personal inspection? What references do you want when we are discussing case reports rather than academic articles? Finally, I don’t see the importance of excluding adjunct care when that care is not known or intended to cure the condition, as in the AS case.

  15. BSM said,

    November 27, 2007 at 11:01 pm

    David,

    You don’t need to know about end-stage pathology! You only need to know about symptoms so stop trying to cheat. Conventional medicine is allowed to peek at the back of the book to find the answers, all you have are symptoms. The fact that the real doctors may have made a proper diagnosis and that diagnosis may be know to you does not affect the claims made for homeopathy nor does it affect your therapeutic approach- take a history, repertorise, prescribe remedy, re-take history.

    In my terms the patient could have chronic myeloid leukaemia or could have Chronic Fatigue Syndrome. I know how to differentiate the two. You are a homeopath. The symptoms are king. It doesn’t matter to you what the patient’s conventionally diagnosed dis-ease is (in the nauseatingly twee homeopathic jargon).

    Please try to be consistent to your ‘paradigm’ or I might have to conclude that you keep homeopathy tucked away from the real challenges of serious disease and safely in a corral with all the problems suffered by middle class people with too much time and too much money where you can apply your placebo to maximum effect. I want you to tell me about real cures of real structural physical disease. The fact that your spondylitis patient wasted their money with you while conventional medicine controlled their signs does not provide evidence for homeopathy. It does provide evidence for the homeopath’s tendency to circle vulture-like on the periphery while real medicine does its job and/or nature takes its course.

    So, I see no reason not to present you with a requirement to come up with a homeopathic cure for something like cirrhosis of the liver. After all, in Hahnemann’s day that would have been a patient suffering dropsy, lethargy and fatty pallid stools.

    Or how about AIDS. Homeopathy has no place for the germ-theory of infection, so it makes no difference to you whether we can measure HIV in the bloodstream and monitor CD4 cell counts, you just have a fevered patient losing weight with a mysterious red skin rash to deal with. How many of those has homeopathy fixed?

    Or breast cancer with spread to lymph nodes.

    Or macular degeneration.

    Or Type 1 diabetes.

    If you are going to start placing limitations on what homeopathy says it can cure then you’re going to have to reject an awful lot of your historical literature.

    I will accept that you are right in pointing out that “even extreme conditions have been recorded to have reversed for unkown reasons” so obviously we’d need to build up a decent set of such cases beyond what would be reasonable. My problem, though, is that list needs to start with its first item and you have not come up with that nor, it seems, has any other homeopath in the history of homeopathy. I wonder why.

  16. BSM said,

    November 27, 2007 at 11:06 pm

    p.s. of course I didn’t mention the MS again, I was rather embarrassed that you had brought it up since it is exactly the kind of chronically fluctuating condition that allows any quackery to make big claims. All you have to do is find a patient willing to let you treat them for long enough and in almost all cases you’ll get a remission phase and the chance to claim you were responsible for it in the insufferable way that homeopaths typically do.

    I would also say David, that having debated homeopaths of a number of years, I will commend you on at least making an effort and accepting the responsibility for trying to make your case.

  17. David / Homeopathy Zone said,

    November 29, 2007 at 9:43 am

    You are either ignorant of homeopathy (your level of knowledge seems that of someone who’s read a “consumer’s guide” about it), or you are deliberately caricaturing it:

    While pathology is not an important diagnostic factor — most of the time other, more specific symptoms will trump it in the hierarchy of important symptoms to consider — it is a crucially important prognostically, as the same symptom may be curable or not depending on pathological basis. In contemporary homeopathic practice the vast majority of patients have ben diagnosed and rediagnosed before ever arriving at homeopathy, whereas historically many homeopaths were MDs versed in the diagnostic tools of their day. For you to suggest that I have no right to refer to pathology is therefore ridiculous.

    Your claims about the AS and MS examples being easily explicable by other factors is baseless: I recognize that my case descriptions were brief, but they were enough to suggest that these were fairly severe cases. The AS patient was in a wheelchair and remained so for the first 2 years of treatment. The MS patient was also in a wheelchair with complete lower-body paralysis (not just weakness or spasticity) and her breathing was beginning to be compromised as the diaphragm was being threatened with paralysis — this is by any measure a severe case. Please provide case examples of remissions from these states rather than claim that they could easily happen. Likewise please provide examples of medical treatment leading to remission and decalcificaiton of a fused spine. The requirement for providing evidence falls on both parties.

    Given your craftiness, it is perfectly reasonable for me to request specific requirements for the sort of evidence you would like me to profer. It is interesting, for example, that you consider AIDS a non-self-limiting pathology but the cases I described are. Where do you get this division from? Do refer me to an evidence base.

    Anyway, my impression is that you are not in the business of “inference to the best explanation” but, just like Shang et al., are doing “inference to the best explanation of the phenomenon that excludes homeopathy”, which means you are not open to the possibility that the best explanation includes homeopathy as you consider it prima facie out-of-the-question. I therefore suggest that we end it here, unless I see an indication that you are willing actually to enter into a debate which you haven’t, thus far, entered.

  18. roGER said,

    November 30, 2007 at 10:09 am

    Thanks for both this article and the longer one, Ben.

    Very well written and you make excellent points.

    Thanks!

  19. CazA said,

    December 5, 2007 at 12:52 am

    BSM,

    i know you only asked for one, but i’m in a good mood, so here are 2 cured cases i found after a 2 minute google:

    graves disease:
    www.hpathy.com/casesnew/schepper-lachesis.asp
    .asp

    chronic pancreatitis (80% reduced function)
    www.hpathy.com/casesnew/barvalia-kali-iod.asp

    you’ll generally find the indian homeopaths have more cases of serious pathology than homeopaths in the uk (for obvious reasons).

    if you’d like more, there are plenty on the site above, plus i suggest you refer to the spring 07 edition of ‘The Homeopath’ (25:4) particulary Banerjea, ‘Pathology & Homeopathy’ pp122-125, which includes cases of cerebral atrophy & abdo tumour.

  20. DrJon said,

    December 5, 2007 at 8:16 am

    CazA: I’m afraid neither of those offer an incontrovertible example, for many of the reasons discussed above. They also do not qualify as scientific proof of any kind. For a description of scientific proof related to homeopathy, see Ben’s guardian article.

    What would it take to convince you homeopathy has no effect?

  21. DrJon said,

    December 5, 2007 at 10:33 pm

    So you admit that the cases you presented didn’t fulfil BSMs criteria? The “reason” you picked is obviously not any of the ones I was referring too.

    How do you conclude I have a closed mind? I am a doctor of philosophy, and will reconsider my opinion based on the evidence. You state that nothing could change your mind – is that the very definition of a closed mind?

    Also, why do you use the word allopathy? Doesn’t this show an inherent bias?

    I’m afraid your experience counts for nothing unless you have scientifically documented it and carried out properly conducted scientific studies.

    You have added nothing new to this debate and repeated the worn clichés that have already been addressed many times here and elsewhere.

    Why, if it so miraculous, does homeopathy score no better than placebo in all well conducted scientific studies? (Please don’t use quantum theory to support your arguments.)

  22. Acleron said,

    December 6, 2007 at 1:39 am

    Sorry late into this thread but fired up from another one.
    CazA uses the words allopathic, personally, dramatic. These can be powerful words but s/he doesn’t mention that a) there is no scientific reason why homeopathy should work and that there is good reasons why it shouldn’t and that b)there is no convincing clinical trial that shows it does work. Apart from trying to continue to make money from people why does anyone practice homeopathy?

  23. BSM said,

    December 7, 2007 at 4:10 pm

    David

    “For you to suggest that I have no right to refer to pathology is therefore ridiculous.”

    I’m afraid the subtlety of the point was lost on you.

    Perhaps you might like to produce me an example of a proving in which histologically confirmed end-stage renal fibrosis was produced by the remedy until consideration. Once you have done that then I will accept your point that conventional pathological descriptions of disease can have some meaningful part to play in your interventions.

    I’m afraid you have fallen into the trap along with all other homeopaths of apeing the mannerisms of conventional medicine in order to appear credible but without understanding that you cannot logically apply it by your own rules.

    That homeopaths do not understand their own philosophy and express mutually contradictory and internally contradictory versions of it is something I have seen time and again. The reason for this is that all of you are basically trading in fictions that do not intersect with the real world and can say anything you like without fear of contradiction because your approach to medical cases renders you incapable of forming valid judgements. Remember, homeopathy is just a set of excuses not a system of medicine.

    “You coudn’t ever convince me homeopathy has no effect as I have personally witnessed dramatic, immediate effects after giving homeopathic remedies, including on animals and babies, where placebo cannot possibly be an explanation.”
    You keep repeating this strawman. Please understand this once and for all. I think the place for placebo in most of homeopathic practice is vanishingly small. Most reported improvements are either coincidental or misrepresentations of the truth.

    The idea that the placebo effect may be important is a sop thrown to homeopaths to allow them to leave the field with a little dignity intact. If you had real effects then you would find it very easy to answer the question;

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

    The fact that you can’t even come up with a half answer should tell you something.

    But if you’d like a specific example to narrow the field, show me a cure of AIDS or metastatic melanoma or end-stage renal failure or Type 1 diabetes or Addison’s disease or rabies.

  24. BSM said,

    December 7, 2007 at 4:18 pm

    “In fact, regards the much touted theory that homeopathy is nothing but placebo, I have always wondered why patients who have been failed by allopathic medicine, and who have tried other alternatives before they finally get to homeopathy, suddenly report feeling better. If they are so prone to suggestion, why didn’t they get better after allopathic treatment or the previous therapies they tried? Do they get to the homepath’s consulting room and suddenly come over all gullible?”

    As I have just pointed out to David, no one is claiming that the effects of homeopathy are all placebo. There is probably a modest placebo effect in some illnesses but not in the majority of significant physical medical conditions. The idea that it is all placebo effect is merely a cover to allow you to hide the real mendacity of the homeopathic community. No, the real processes behind most homeopathic tales of successes are simply lies or misunderstanding of the natural history of disease so that coincidental changes are reported as success for homeopathy or real outcomes are concealed or justified by one of the set of excuses that homeopathy provides.

    If you are a homeopath, will you have the honesty to tell us whether you have ever cured a major physical disease or whether you piddle around with trivial lifestyle conditions like most homeopaths and/or piggyback your practice on the expectation that asthma or eczema or irritable bowel syndrome will fluctuate into improvement phases for which you an claim credit?

  25. David / Homeopathy Zone said,

    December 8, 2007 at 11:14 am

    BSM,

    Your point about pathology being produced in provings shows that you are ignorant of the fact that the remedy picture is not merely made up of the proving (again, this is the “consumer’s guide” first-approximation explanation), but also on toxiocological data where available, and also on cured cases thereafter.

    I’ve earlier given examples of what should be considered impressive results, which you dismissed without providing the criteria on which you based your dismissal. Another reader provided examples that were likewise dismissed by someone else.

    Yes, there is a small number of cures of rabies in the homeopathic literature, which are available to all for inspection. I don’t, however, see the point of presenting them to you only for them to be dismissed as fraudulent, misdiagnoses, etc.

    As I’ve mentioned above, you already know the truth even though you are obviously ignorant of the clinical reality of homeopathy, and so there is no point in furthering our debate.

  26. markgdavis said,

    December 11, 2007 at 9:30 am

    BSM, Ben, and David,
    I’m a second-year student of naturopathic medicine in Portland, Oregon, USA. Just so you know, the ND degree confers the same prescriptive rights as the MD degree in several states, so the education involves just as much science–graduate level biochemistry, histology, pathology, microbiology, etc.
    Part of the required coursework at my school is 4 or 5 quarters of homeopathy, and I’ve just finished the first quarter.
    Now, I’m perfectly willing to believe that homeopathy is complete hogwash, and stick to remedies like pharmaceuticals, nutritional advice, botanical medicine, counseling, etc.
    But as far as I’ve seen, the evidence weighs in on the side of the homeopaths. The Linde and Kleijnen meta-analyses cited by Ben show efficacy for homeopathy, so it’s really weird that the opening paragraph of the Lancet article cites them as indicating that “homoeopathy produced no statistically
    significant benefit over placebo”. I wasn’t able to find the abstracts for the Boissel and Cucherat, but the comments by David (and the ones he cited by Linde) about the Shang study make that a questionable source for me.
    If you want peer reviewed studies, I reference four in comment #26 above, which I was a little disappointed that no-one responded to. And I could throw more your way if you’re really interested.
    If you want individual cases, come on, don’t ask for cures of type I diabetes or end stage renal failure. I mean, I’m going to be a doctor, and I want to evaluate whether I can use pharmaceuticals or nutritional advice or homeopathy, etc. to fix somebody, and y’know, I just don’t think any of those things will fix someone’s type I diabetes. But can nutritional advice help them control their symptoms? Yeah! can pharmaceuticals or homeopathy help their lives? Maybe.
    The only criticism that really makes me question homeopathy is the idea that publication bias may have lead to a statistically inevitable number of false positive studies, but that’s far from a searing condemnation… more like a suggestion that you should be careful when building up your beliefs using peer reviewed studies as your guide.
    As of right now, I imagine that when I graduate, I’ll be inclined to try homeopathy when my patients are kids with diarrhea, or arthritis or rhinitis sufferers. Or, for that matter, kids with otitis media, which I hear I’ll probably see a lot.
    If anyone can tell me why to disregard the studies cited above, or why to think weak statistical significance for efficacy translates to no significant benefit, I honestly could be swayed from using homeopathy.
    I really hope to hear from someone, and thanks for all the eloquent criticism of and support for homeopathy that I’ve heard so far.

  27. BSM said,

    December 17, 2007 at 4:04 pm

    markgdavis said

    Now, I’m perfectly willing to believe that homeopathy is complete hogwash, and stick to remedies like pharmaceuticals, nutritional advice, botanical medicine, counseling, etc.

    I think you mean imperfectly. :-)

    Linde revised his findings, but the homeopaths only quote the 1997 version with flawed results not the revision. Both Linde and Kleijnen at best offer very weak support for homeopathy which basically says any effects are lost in the statistical noise and this is what we would expect for a placebo not what we would expect for this allegedly all-conquering therapeutic system.

    If you want individual cases, come on, don’t ask for cures of type I diabetes or end stage renal failure.

    I think you have just disqualified yourself from comment. Let me remind you that homeopathy originated in a world in which no such diagnoses could have been made. All the homeopath would have would be the symptoms the patient told him about. So, we now might be able to determine that the patient has cirrhosis, but the homeopath would only have seen ‘dropsy’ and ‘jaundice’. As I said to David previously, you as a homeopath are disallowed modern medical diagnostic methods. If you insist on acting in accordance with modern diagnoses then you must reject as utter fiction the vast bulk of your historical case records. Why? Because historical homeopaths were treating just these end-stage patients that modern medicine can accurately describe but reporting alleged successes regardless. This, if any more was needed, should tell you that the homeopathic literature is just a work of the human imagination, having no more bearing on real medicine than astrology.

    I would remind you that homeopathy is supposed to be a “complete system of medicine” not a system restricted to dealing in trivia.

    As of right now, I imagine that when I graduate, I’ll be inclined to try homeopathy when my patients are kids with diarrhea, or arthritis or rhinitis sufferers. Or, for that matter, kids with otitis media, which I hear I’ll probably see a lot.

    So no danger of having your prejudices and preconceptions challenged. That’s just hopeless.

    So, you’ll take money for treating self-limiting conditions that fluctuate or resolve spontaneously. Very honourable. Not.

    David said;

    Yes, there is a small number of cures of rabies in the homeopathic literature, which are available to all for inspection

    OK, then cite one properly documented case. Unless you can do that I shall file this along with the other Big Fat Lies that have to be told to keep homeopathy’s show on the road.

    Your point about pathology being produced in provings shows that you are ignorant of the fact that the remedy picture is not merely made up of the proving (again, this is the “consumer’s guide” first-approximation explanation), but also on toxiocological data where available, and also on cured cases thereafter.

    Forgive me, but that is just utter bollocks. Even if it were not close to being a literal untruth, it would still be bollocks, because accumulating ‘cured cases’ in the completely non-systematic way of homeopaths is no evidence of anything. This is your whole problem. You think you have this marvellous secure evidence base but are so blinkered in your belief that you cannot see it has been knitted from fog.

    Where is the toxicological data for “Light of Venus” or “Peregrine Falcon”? Pull the other one, it has bells on it- being an attractive English idiomatic phrase expressingly cynical disbelief.

  28. BSM said,

    December 18, 2007 at 7:50 am

    markgdavis said

    If you want peer reviewed studies, I reference four in comment #26 above, which I was a little disappointed that no-one responded to.

    Which werel;

    RCTs I’ve read that show efficacy for homeopathy include:
    Jacobs et al, “Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua,” Pediatrics, Volume 93, Number 5, pp. 714-725 (May 1994)
    Jacobs et al., “Homeopathic Treatment of Acute Childhood Diarrhea: Results from a Clinical Trial in Nepal,” Journal of Alternative and Complementary Medicine, Volume 6, pp. 131-139 (2000)
    Gibson et al., “Homoeopathic Therapy in Rheumatoid Arthritis: Evaluation by Double-Blind Clinical Therapeutic Trial,” British Journal of Clinical Pharmacology, 9, pp. 453-459 (1980)
    Taylor et al., “Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series,” British Medical Journal, 321, pp. 471-476 (19 August 2000)

    All rubbish. Badly defined end-points. Badly designed controls. All the usual things.

  29. BSM said,

    December 19, 2007 at 1:01 pm

    David, I’m afraid you are just being silly and raising strawman arguments.

    1. We know the homeopathic literature is untrustworthy, but I don’t expect it contains many outright lies. If you can come up with a properly documented case record of the type I have described then it would be interesting. So far you have not even made the attempt.

    2. I dismiss your first hand evidence as unimpressive because it is unimpressive and conforms to a standard pattern: the homeopath one is talking to only has rather feeble cases available, but they’re sure they’ve heard of someone or read something once that should a really dramatic cure of cancer/rabies/AIDS (delete as appropriate).

    3. I have not dismissed articles in mainstream journal without proper argument. Give me one example, where you have read the full-text and are prepared to defend it and I will go through that paper with you, but bear in mind that the lesson of the meta-analyses has been that no homeopathic papers exist which can bear proper scrutiny or are anything other than statistical anomalies. But, please feel free to look for one.

    4. This point requires an understanding of the statistics at play in these papers. The point I was making, however is that homeopathy claims strong reliable real effects in patients. The mere fact of having to hunt for tiny effects in the statistical noise disproves the main claims of homeopathy. For instance, one of the papers of Oscillococcinum did manage to find a p value of “So, I see no reason not to present you with a requirement to come up with a homeopathic cure for something like cirrhosis of the liver. After all, in Hahnemann’s day that would have been a patient suffering dropsy, lethargy and fatty pallid stools.
    Or how about AIDS. Homeopathy has no place for the germ-theory of infection, so it makes no difference to you whether we can measure HIV in the bloodstream and monitor CD4 cell counts, you just have a fevered patient losing weight with a mysterious red skin rash to deal with. How many of those has homeopathy fixed?
    Or breast cancer with spread to lymph nodes.
    Or macular degeneration.
    Or Type 1 diabetes.
    If you are going to start placing limitations on what homeopathy says it can cure then you’re going to have to reject an awful lot of your historical literature.”

    I will repeat again that it is only since the advent of modern medicine that the clinical syndromes and symptom-pictures with which such patients present would lead to an untreatable conventional diagnosis. Patients always had these diseases we just didn’t have the means to apply the current set of labels to them. Throughout homeopathy’s history these patients would simply have received remedies targeted at the symptoms. So, I specifically do not allow you to shy away from diseases that conventional medicine calls ‘untreatable’. Homeopaths pretend to treat AIDS and cancer, it would be futile for you to deny this. So, please come up with a properly documented case, or learn something from your inability to do so.

    David, I have spent years honestly evaluating the evidence advanced by homeopaths. All I have found have been misrepresentations, lies, confusion and mainly badly designed studies. I have found some good studies: these are negative. There have been a number of attempted provings done under properly controlled conditions rather than the joke protocols that homeopaths usually call controlled. These have been done by homeopaths. Look these up. They have all been failures. Why? Because homeopathic “provings” are works of the imagination not recordings of genuine facts.

    Here’s a short list. All done by homeopaths. The failures by Harald Walach seem to have driven him to declaring that homeopathy works by magic at which point homeopathy and reality finally part company for the last time.

    Brien et al Ultramolecular homeopathy has no observable clinical effects. A randomized, double-blind, placebo-controlled proving trial of Belladonna 30C B J C Pharm, 56, 562-568. (2003)

    Walach et al The effects of homeopathic belladonna 30CH in healthy volunteers – a randomized, double-blind experiment. J Psychosom Res 50 155-160. (2001)

    Vickers et al Can homeopathically prepared mercury cause symptoms in healthy volunteers? A randomized, double-blind placebo-controlled trial. J Alt Comp Med. 7 141-8. (2001)

    Goodyear et al Randomized double-blind placebo-controlled trial of homoeopathic ‘proving’ for Belladonna C30. J R Soc Med 91 579-82. (1998)

    Walach Does a highly diluted homeopathic drug act as a placebo in healthy volunteers? Experimental study of Belladonna 30C in a double blind crossover design – a pilot study. J Psychosom Res 37 851-860. (1993)

    This is your literature, David, you should have been familiar with it.

    You are a young man with a long career ahead of you. Go and do something useful with your life instead of wasting it on the pack of lies that is homeopathy. It’s a big interesting world out there. All homeopathy does is force you to view it through distorting lenses. That is not healthy and it is a sad waste of one’s life, which may be why we see such desperation when it is challenged.

  30. David / Homeopathy Zone said,

    December 19, 2007 at 7:49 pm

    BSM,

    I appreciate your genuine concern for my homeopathic soul. I guess I will have to keep living in my alternate reality, helping people not helped by those living in your vastly superior one (I love to catch all of those regressions to the mean just in time; evidently the medical community has less talent in this game).

    You have still not given me the incontrovertible criteria that you so adamantly demand. Evidently they cannot be produced, and it is therefore not surprising that in all your years of demanding them they haven’t been satisfied, as they couldn’t be even if homeopathy were real.

    As far as I can tell, you don’t seem to have, in all your years of evaluating homeopathy, spent appreciable time in a clinical setting with a senior homeopath and engaged in long-term observation of chronic cases — as I said this is the only way that a die-hard skeptic would potentially be able to gather the necessary evidence to perturb one’s conviction. Then you might have remained skeptical, but you would have had other, far more concrete and convincing reasons on which to base your case, as opposed to the theoretical dismissals that you keep offering.

    Regarding studies, your confident pronouncements (whereby you parse studies for quality by their conclusions) are simply ludicrous. They are nothing more than a personal reading in the spirit of Shang et al.: “I will assume that all positive results could be explained as [insert criticism here]”. You are obviously not open to a chain of reasoning in which the consequence is yet-undetermined, as yours is predetermined.

    I will end my participation in this thread here; feel free to add a coup de grace.

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  33. MHodges said,

    December 2, 2013 at 12:37 am

    [sigh] yet another sad piece of evidence rolling in countering the myth of the ‘harmlessness’ of homeopathy (via Stephen Barrett’s post in Consumer Health Digest today):

    “Mother of dead boy arrested for avoiding medical care-
    Tamara Lovett, of Calgary, Canada, whose 7-year-old son Ryan died last March from a medically treatable streptococcal infection, has been charged with criminal negligence and failure to provide the necessaries of life. Press reports state that Lorett had never taken him to a doctor, had a belief system in homeopathy, and had used “holistic remedies” to treat the infection even though Ryan was bedridden for ten days and looked very ill. [Schmidt C. Calgary mother arrested in death of young son. CTV News, Nov 22, 2013]”

    Read more: calgary.ctvnews.ca/calgary-mother-arrested-in-death-of-young-son-1.1555943#ixzz2mH0Kjq1u

    “…but there was a belief system in homeopathic medicine that did factor in.”

    ###